12000 SW KING GEORGE DRIVE AdL -�..�
- 12000 King George Drive -—
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IT`r OF TIGARD MECHANICAL PERMIT Receipt# !%
Permit #_
Description
Table 3A Mechanical Code aTY PRICE AMT
City of Tigard ---- —_ —— --r _ _
13125 S.W. Halt Blvd. t) Permit Fee -0- -0- 10.00
P.0 Box 2337 --- ��— --
Ig2 d, OR 97223 2) Supplemental Permit 3.00
6?'.-4175 Furnace toS00,000BTU _ —
1) incl.durtd&vents 6.00
2) Furnace 100,000 BTU +
Incl.ducts&vents 7.50
Nance of Development 3) Floor Furnace
Incl.vent 6.00
JC`1 ---dress
- Suspended heater,wan heater
Address 4) or floor mounted heater 6.00
)
Tax Lot Map N� --- 5 Vent not incl.in
Lot Black Subdwi..ion ——_ -- - — ---
_ appliP.ice permit 3.00
_
Name(or name of business) 6) Repair of heating,refr ig.,
cooling,absorption unit 6.00
Owner Mafling Address Phone 7) Boiler of comp to 3 HP _
absorp.unit to 100,000 BTU 6.00
Clty'Slate zip _ Boiler or comp to 3 HP-15 HP
6) absorp.unit to 500,000 BTU 11.00
Name 9) Boiler or comp 15-30 HP ~f
absorp.unit 1/2-1 million 15.00
Halling Address Phone Boiler or comp to HP
' 10) absorp.unit 1-1.755 million
22.50
Contractor cit 'staleBoiler or compto 50 HP
y -p 11) absorp.unit 1,750,000_B_TU 31.50
Slate Registration No. — City Bus.TaxNo. Air handling unit to
12) 10,000 CFM 4.50
I hereby acknowledge that I have read this applicatio i thet the informationgiven is 13) Air handling unit
3,thnt I am the owner or authorized agent of the own ir,that plans submitted are in 000 CFM + 7.50
compliance with State laws,drat I am registered with the State Builders'Board,that the 14 Non portable
numbs-given Is correct.(It exempt from State registratirm please give reason below). f evaporate cooler 4.50
-- �_ Vent fan connected
to a single duct 3.00
Ventilations stem not
16) included in appliance permit I 4.50
Hood served by
17)
mechanical exhaust
4.50
Signature town r or agent) — Dale Domestic type —
--__
Describe y/ork (-1 ad61tion f_1 alteration 1-1 repair El ) Incinerator 7.50
to be dorle _ residential U non-residential [1 _ ommercial or industrial
Existing use of" — 19) type Incinerator 30.00
building or properly __... _ Other i.e.,woodstc.- %Nater
20) 4.50
Proposed usc�of _t,eater,solar,clothes dryers,bw.
building or xeperty -
- 21) Gay piping one to four cutlets 2.00
Type of f, dl- oil I -1 natural gas CI LPO , l electric [I
— 22) More than 4-per outlet
PIOTICE —THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON- _ SUB-TOTAL
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 190 4e/,SURCHARGE
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL e -
ALANDONED FOR A PERIOD OF 190 DAYS AT ANY TIME AFTER ----- -- _—_ —
WORK IS C01,41MENCE0. TOTAL
Special Conditions
- -- - ----_.... ----- -- - --- Date issued ---
.. x-+•�...w.a- .,.... .�....._........«v..._..... n.....,- .y. ,r�iyr ylF.v..w..�..m..+wM r.wwnMR'M'1N4MM' •+Mr h!
r nv ......., .-., .,,... -... .ry t .,ewwmx•.n y...rte �M.
BUILDING PERMIT APPLICATION KING CITY DAVE �. -pt= 197-
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR TH,_ WORK HEREIN INDICATED SUILDI-'R PHONE_
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNES PHONE—_.._.
LOT NO. _
OW,.-R !I ? JOB ADDRESS HOME ADDRESS - -
r`� -- - —ARCHITECT
'torn Awto- ENGINEER
BUILDER r-1 W 0- ADDRESS _ _ _ DESIGNER
O
STRUCTURE NERI MnDEL ❑ADDITION REPAIR ❑RENEWAL ^FIRE DAMAGE DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELI(,IOUSOPATIO ❑CARPORT ❑GARAGE ❑STORAGE SLAB LIFENCE
OBCNJ ❑MOVING ❑CONDITIONAL USE DESIGN REVIEW E' ,OUNCIL APPROVED ❑,Ir.,r„s
OCCUPANCY----LAND USE ZONE _BLG_G. 1 YP_E�.= FINE ZONE PLAN CHECK 9YHEAT
f uwpl. ] i u6 with lark gi-epr annh91t q),,j.n;*lw,4 pmr cortrsr,It n;rretwr-ont .
'9KI.€S_—.—. A EA —
__BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SINE
_._ -- -- -
--- - — rNIG PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check gEt,ULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
-- - IVORK W!LL. BE DONE IN ACCORDANCE WITH THE PtANSAND SPECIFICATIONS AND IN COMPLIANCE WITH
SUb total ;ILl. APPLICABLE CODES .AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTonS 10 HAVE CURRENT CITY 1111SWESS
State Tax ' JCENSE. SEPARATE PERMITS REOUIRED FOR SEWER, PLUMBING AND HEATING.
Otal t l
By n�.._._ — - - - -
r>nl if AN I Op AGENT
1
�s
DATE INSP.I fPIE INSPECTION REMARKS PLUMBING DATL
Contractor
Permit No,
Hough-in
Fixture
Final
HEATING
Contractor
Parmit No.
Gas or 011
Rough-in
Final
SEWER
Final
DRIVEWAY
Fina
Storni Drainage
(Rain DralnI Final
Sidewalk
Curb&Street Final
Apt3roach
BLDG. DEPT. FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY
LenditcapInit
Zoning Final